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Published on: September 14, 2017
Population-based Canadian hip fracture rates with international comparisons
W D Leslie1, S O'Donnell, C Lagacé
1Faculty of Medicine, Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada. bleslie@sbgh.mb.ca
Insights
Canadian hip fracture rates are lower than in the US and Germany. The US fracture risk assessment tool (FRAX) is not suitable for Canada, as it overestimates risk in Canadian women and older men.
Area of Science:
- Orthopedics
- Epidemiology
- Public Health
Background:
- The World Health Organization (WHO) recommends calibrating fracture risk assessment tools to specific populations.
- Proximal femoral fractures, commonly known as hip fractures, represent a significant public health concern.
Purpose of the Study:
- To assess hip fracture rates in Canada from 2000-2005.
- To evaluate the appropriateness of the US fracture risk assessment tool (FRAX) for the Canadian population.
Main Methods:
- Analysis of Canadian hospitalization data for proximal femoral fractures (2000-2005).
- Comparison of age-standardized hip fracture rates across Canadian provinces.
- National hip fracture rates were compared with data from the USA and Germany.
Main Results:
- Hip fracture rates varied minimally between Canadian provinces.
- Canadian women exhibited substantially lower hip fracture rates compared to women in the USA and Germany.
- The US FRAX tool would overestimate fracture risk in Canadian women and older men.
Conclusions:
- Canadian hip fracture rates are lower than those reported in the USA and Germany.
- Country-specific fracture data are crucial before adopting existing fracture risk assessment tools like FRAX.
- The findings highlight the need for a Canadian-specific FRAX calibration.
Summary:
We identified hospitalizations throughout Canada during 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture. Use of the US fracture risk assessment tool (FRAX) would be inappropriate for Canada as it would overestimate fracture risk in Canadian women and older men.
Introduction:
It is recommended that the WHO fracture risk assessment tool should be calibrated to the target population.
Methods:
We identified hospitalizations for women and men throughout Canada during the study period 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture (147,982 hip fractures). Age-standardized hip fracture rates were compared between Canadian provinces, and national rates were compared with those reported for the USA and Germany.
Results:
There were relatively small differences in hip fracture rates between provinces, and most did not differ appreciably from the Canadian average. Hip fracture rates for women in Canada in 2001 were substantially lower than in the USA (population-weighted rate ratio 0.70) and were also lower than in Germany for 2004 (population-weighted rate ratio 0.74).
Conclusions:
Overall hip fracture rates for Canadian women were found to be substantially lower than those for the USA and Germany. This study underscores the importance of assessing country-specific fracture patterns prior to adopting an existing FRAX tool.
